TAILIEUCHUNG - RATIONAL AND SOCIAL CHOICE Part 10

Các thông tin không bệnh nhân được giả định để biết về tình trạng sức khỏe kém, nhưng bản thân ông không phải là bị bệnh, ông được giả định là hợp lý và ích có thể là khả thi để cố gắng để tương phản các giá trị bệnh nhân có khả năng và các giá trị bệnh nhân không thông báo trong một cách song song với sự tương phản giữa tiện ích có kinh nghiệm và tiện ích quyết định (Kahneman et al 1997) | 530 AKI TSUCHIYA AND JOHN MIYAMOTO such respondents informed non-patients . The informed non-patient is assumed to know about ill health states but he himself is not ill he is assumed to be rational and selfish. It may be feasible to try to contrast the capable patient values and the informed non-patient values in a manner parallel to the contrast between experienced utility and decision utility Kahneman et al. 1997 . While all four concepts are about how states of ill health are perceived capable patient values and experienced utility are concerned with how things actually feel in real time when the individuals are living with the condition in question whereas informed non-patient values and decision utility capture how people thinkthey would feel were they to experience these states. In other words the informed non-patient corresponds to the consumer before consumption contemplating consumption of a good and the competent patient corresponds to the consumer after consumption having purchased the good. While using the values obtained from informed non-patients is closer to the framework of consumer theory based on decision utility in a move parallel to the emergence of interest in experienced utility in the recent economics literature there is an emerging interest in values obtained from competent patients in the health economics literature Brazier etal. 2005 . Non-Welfarism and the QALY as the Desideratum On the other hand there is an alternative approach within health economics which holds the QALY as the social desideratum not because it is valued by individuals as patients or consumers although it may well be but because it is valued by the public at large or the relevant decision-makers . policymakers in the National Health Service or the Department of Health . This approach has been referred to as the decision-makers approach Sugden and Williams 1978 or extra-welfarism Culyer 1989 . While some authors distinguish between the two here they are not .

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